All posts by Dr Deepan

Dr DEEPAN P SHAH MD(HOMOEOPATHY) SPECIALISED HOMEOPATHIC PHYSICIAN AND SURGEON

DMD – DUCHENNE MUSCULAR DYSTROPHY

DMD – DUCHENNE MUSCULAR DYSTROPHY also called DUCHENNE SYNDROME is a X linked recessive genetic disorder; classified under progressive neuromuscular disorders; where in there is mutation of gene expressing the cytoplasmic protein “Dystrophin” causing muscle weakness and wasting.

DYSTROPHIN

Dystrophin expressing gene is one of the longest human genes known with 2.3 megabases present on short arm of chromosome X present at locus xp21,

Various proteins colocalises with dystrophin to form Dystrophin-Associated Protein Complex or Costamere. Costamere is an integral component in maintaining structural-functional integrity of striated muscle cells. As Costamere are responsible for linking of internal cytoskeletal system of each muscle fibers to extracellular matrix of collagen and laminin through cell membrane. So costamere connects sarcomere through sarcolemma to the extracellular matrix. So mutation in gene responsible for expressing cytoplasmic protein dystrophin causes structural-functional loss of muscle cell resulting into muscular dystrophy.

Dystrophin plays major role in function of binding of following molecules

  • Nitric Oxide Synthase
  • Dystroglycan
  • Vinculin
  • Myocin
  • Actin
  • Other proteins
  • Zinc and other metal ion
  • Other cytoskeletal and muscle constituents

THUS DYSTROPHIN PLAYS MAJOR ROLE IN BIOCHEMISTRY OF MANY PHYSIOLOGICAL ACTIVITIES

  • Regulates Ryanodine-sensitive calcium-release channel activity, release of sequestered calcium ion into cytosol by sarcoplasmic reticulum, activity of voltage-gated calcium channel. It is required in activity of Sodium ion transmembrane activity.
  • Downregulates peptidyl-cysteine S-nitrosylation and peptidyl-serine phosphorylation, Cellular protein localization, cellular macromolecular complex assembly, peptide biosynthetic process.
  • Upregulates Neuron differentiation, neuron projection development, sodium ion transmembrane transporter activity.
  • Cardiomyocyte action potential, contractibility by regulating release of sequestered calcium ion thus playing major role in regulating the Heart Rate.
  • Myocyte cellular homeostasis. Myofibril development, sliding, response to stretching, Regulates skeletal muscle contraction by regulating release of sequestered calcium ion, required in cytoskeleton organization.
  • It regulates cellular response to Growth Factor stimulus. Thus it is also required in growth and development of muscle organ.

EPIDEMIOLOGY OF DMD

Duchenne’s Muscular Dystrophy one of the most common type of muscular dystrophy affecting 1 in every 5000 male at birth with life expectancy of affected individuals of around 25 years on an average. Many cases show increase in life expectancy of up to additional 10-15 years with proper care and management.

SIGNS AND SYMPTOMS OF DMD

DMD presents itself with progressive muscle wasting, general weakness fatigue, debility, in later stages complete loss of power in muscles. This loss of power is attributed to muscular dystrophy rather than nerve involvement which is evident on EMG.

Initially there are not many noticeable symptoms but some parents may complaint of child having difficulty in milestone of turning over, or they may say not able to walk properly or “never saw him running or climbing stairs”.

Mental signs and symptoms may start presenting itself more evidently, well in advance, even before physical symptoms become evident. They may show cognitive difficulty, parents may complaint about child having difficulty in talking or getting words, short term verbal memory, many show symptoms of Dyslexia or ADHD and mental symptoms tend to improve after occupational and speech therapy during early childhood but again worsens in later stage of disease.

Physical signs and symptoms starts becoming frankly noticeable only after age of 2-3yrs as described below

General muscle wasting with muscle contractures due to fibrosis the muscles becomes short and they have hypertonicity with much of muscle fibre replaced with fibrous tissue or fat accumution all this gives rise to Pseudo-hypertrophy of muscles especially of calf, hips and shoulders, even tongue becomes thick and enlarged.

At first the muscles of calfs, extensor of knees other muscles of thigh and hip joint are involved then other pelvic muscles and shoulder gets involved so the disease progresses from below upwards

Skeletal deformities due to abnormal muscle tension distribution causing abnormal gait and resultant skeletal deformities like scoliosis, lumbar hyperlordosis

Difficulty walking -typically patient walks on forefeet or toes, running, jumping, hopping, climbing upstairs or down stairs.

Difficulty standing up from lying or sitting posture. Positive Gower’s Sign. If patient is sitting on ground he typically first puts his arms on floor and transfer upper body weight to ground through arms and the lifts pelvic region now with both arms and both knees touching ground and middle body lifted up, he then lifts one knee by putting foot on ground then he works his arms to lift other knee and then stand up by supporting thigh.

Due to muscle dystrophy and weakness patient has abnormal gait and they tend to fall to frequently so they frequently complaint about bodyaches which seems more to be due to trauma due to frequent falls rather than due to disease itself.

In later stages there is complete loss of ability to walk at around 12 yrs of age around and later on at around age of 20yrs there is complete inability to move body from below neck.

Patient’s respiratory muscles gets involved in later stage causing respiratory disorders where in they are required to be assisted with artificial ventilation. Food and fluids pass into respiratory passage. Patient may suffer from severe frequent Pneumonia.

Average life span of person is around 25 years and very few with extreme care have reported to reach out 45yrs of age.

Laboratory Investigations Shows

  • Cardiomyopathies (disorders of heart muscles) causing arrythmias (abnormal heart rhythm)
  • High blood Creatine-Kinase level.
  • Defects in Xp21 gene
  • Biopsy of muscles shows absence of dystrophin
  • High blood Creatine-Kinase level.
  • EMG shows changes of muscle dystrophy rather than nerve involvement

DIAGNOSIS OF DMD

  • DNA testing
  • Muscle Biopsy
  • Prenatal Screening

HOMEOPATHIC TTREATMENT WITH INDICATED MEDICINES FOR DMD

As DMD is a deep seated genetic complaint that passes on generation to generation. So Homeopathic constitutional approach is required and more the disease becomes deep seated and more it passes on from generation to generation the more it starts manifesting it’s symptoms in mental sphere. So mental symptoms are to be carefully evaluated for Homeopathic individualisation at the same time one should not forget that even though the disease has manifested in mental sphere but it’s more pronounced on physical sphere where it shows typical ascending type of muscle wasting. Muscle dystrophy is due to defective production of dystrophin which primarily is functional disturbance and structural loss is secondary to it. So basically Psora has strongly established itself from generations to generations within the constitution of these patients.

HOMEOPATHIC MEDICINES FOR DMD

  • Abrotanum – ascending muscle wasting – If one medicine for DMD patients is to be opted, which in most cases will act to certain degree, then my bet will be on abrotanum – personally I have got notable results with this medicine in cases of DMD if posology is well taken care of while administering, as in homeopathy it’s potency selection and repetition is the key to break the case!
  • Baryta Carb
  • Calcarea Carb
  • Calcarea Phos
  • Stannum Metallicum
  • Alfalfa
  • Agaricus Muscarious
  • Arsenicum Album
  • Zincum Metallicum
  • Phosphorus
  • Acidum Nitricum

SUPPORTIVE TREATMENT AND MANAGEMENT

Exercise -mild non-jarring like swimming helps maintain muscle strength without stressing or damaging it much

Physiotherapy helps to maintain muscle tone.

Supportive rehabilitation kits and orthopedic appliances like braces etc

Artificial respirator support in later stages when respiratory muscles starts weaknening

Pacemakers in patients with arrhythmia

MOTOR NEURON DISEASE (MND)

Motor Neuron Disease though most commonly used to mention one specific disease ie Amyotropic Lateral Sclerosis(ALS), Motor Neuron Disease is actually a classification category that comprises all the diseases that are of motor-neurodegeneratory in nature. But Amyotropic Lateral Sclerosis being the most common form of Motor Neuron Disease, it has vaguely become synonymous to its parent classification category.

Diseases Classified Under Motor Neuron Diseases

Diseases are very vaguely placed into this category with inconclusive inclusion and exclusion criteria. Following are the basic disease types that fall under this category or one can say they form this category.

  • Amyotropic Lateral Sclerosis(ALS) or Lou Gehrig’s Disease
  • Progressive Bulbar Palsy(PBP)
  • Progressive Muscular Atrophy(PMA)
  • Primary Lateral Sclerosis(PLS)
  • Pseudobulbar Palsy
  • Monomelic Amyotrophy
  • Other Rare Forms

Motor Neuron Diseases are characterised by progressive muscle weakness and degeneration of motor neuron. But as explained earlier that classification is vague, so not all motor neuron degeneratory disorders fall under this category and rather they are placed into a broader category called “Motor Neuron Disease Disorders” example Spinal Muscular Atrophies falls into this broader category.

Motor Neuron Diseases can be further differentiated based on three creterias as follows

  1. Sporadic or Inherited
  2. Type of Neuron Involved
  3. Pattern of Muscle weakness.

1)Sporadic or Inherited

Except Familial Amyotropic Lateral Sclerosis rest all are Sporadi

2) Type of Neuron Involved

There can be Involvement of neuron in three different patterns

  1. Upper Motor Neuron Degeneration – Except Progressive Muscular Atrophy(PMA) all other types have UMN involvement
  2. Lower Motor Neuron Degeneration – Except Primary Lateral Sclerosis, Pseudobulbar Palsy and Monomelic Amyotrophy rest all have LMN involvement.
  3. Both Upper And Lower Motor Neurons Involved – Types under this category are ALS PBP(bulbar)

3)Pattern of Muscle Weakness.

Pattern of muscle weakness can be in combination of following three factors

  1. Symmetric or Asymmetric
  2. Proximal or Distal
  3. With or Without Sensory Loss.

Based on combination of above three criterion the pattern is categorised into three major pattern of combination.

  1. Asymmetric – Distal -Without Sensory Loss : ALS, PLS, PMA, MMA
  2. Symetric – Without Sensory Loss : PLS, PMA
  3. Symmetric Focal Midline – Proximal : ALS, PBP, PLS

SIGNS AND SYMPTOMS OF MOTOR NEURON DISEASE

MND can present itself in children or in adults. If the onset is during childhood then it’s usually inherited and in most of the cases it is Familial Amyotropic Lateral Sclerosis. In adults usually it’s found to affect after age of 40years.

Most of the cases of MND tend to progress during course of time and worsen and in many cases they are even fatal depending on type of MND, say for instance ALS is a fatal type where as PLS is not.

Motor Neuron Disease presents itself in various patterns of muscular weakness due to motor neuron degeneration which can show combination of patterns of symmetric or asymmetric, proximal or distal, focal midline or lateral, with or without sensory loss. Some of the signs and symptoms of Motor Neuron Disease are listed below.

  • Muscle Wasting, Twitching, Fasciculations.
  • Atropthy of tongue
  • Brisk reflexes
  • Babinski’s reflex
  • Hoffman’s reflex
  • Increased Muscle tone
  • Difficulty in breathing, aggravated while lying down or on exertion. It may also cause respiratory failure.
  • Dysphagia – Difficulty in swallowing
  • Sialorrhoea – Excessive salivation
  • Dysarthria – Difficulty in speaking
  • Cognitive and behavioral changes like decision making, computing, word fluency, memory etc.

Common Homeopathic Medicines for Motor Neuron Disease

Homeopathic Medicine should be selected as per type of Motor Neuron Disease and it’s symptomatology.

  • Plumbum Metallicum
  • Strycininum
  • Alumina
  • Anacardium Orientale
  • Baptisia Tinctoria
  • Kalium Phosphoricum
  • Ruta Graveolens
  • Syphillinum
  • Medhorrinum
  • Gelsemium Sempervirens
  • Thuja Occidentalis
  • Cactus Grandiflorus
  • Causticum

MULTIPLE SCLEROSIS (MS)

Multiple Sclerosis(MS) is disorder of central nervous system characterised by Demyelination, Inflamation and Sclerosis supposed to be either immune mediated or due to defective myelin production or combination of both.

Myelin sheath is produced by cells called oligodendrocytes. Myelin sheath is necessary to conduct electrical signals through neurons.

Genetics, Lifestyle and Environmental factors are believed to be contributing to the development of the disease and viral infection is believed to be the triggering factor.

SIGNS AND SYMPTOMS OF MULTIPLE SCLEROSIS

Multiple Sclerosis in many patients starts as Clinically Isolated Syndrome (CIS), it is the term used for the very first episode of neurological symptoms in demyelinating diseases. It is currently considered as the best indicator of future probability of development of multiple sclerosis. In multiple it typically develops over days in which

  • 45% of cases presents with signs of motor and sensory deficits
  • 20% of cases presents with optic neuritis
  • 10% of cases presents with brain stem dysfunctions
  • 25% of cases shows more than one of the above

Types Of Multiple Sclerosis

Multiple Sclerosis International Federation Classifies MS into 4 types

  1. Clinically Isolated Syndrome (CIS)
  2. Relapsing Remitting Multiple Sclerosis(RRMS)
  3. Primary Progressive Multiple Sclerosis(PPMS)
  4. Secondary Progressive Multiple Sclerosis(SPMS)

MS may present itself in three basic pattern as mentioned below

  • RELAPSING – 85% of all the cases shows this pattern. In this the symptoms comes and goes away lasting for few days to months.
  • PROGRESSIVE – 10% of all the cases shows this pattern. In this form the symptoms develops and persists and keeps building up over time.
  • COMBINED – In this the symptoms appears stays there and keeps building even further on every subsequent attack. In many cases it starts as relapsing and later turns into progressive form

A patient may show symptoms of neurological deficits in any part or system depending upon the region of Central nervous system involved. The most commonly affected regions are white matter of optic nerve, brain stem, basal ganglia, spinal cord, white matter tract close to lateral ventricles causing following common symptoms.

  • Weakness
  • Fatigue
  • Mood disorders
  • Depression
  • Anxiety
  • Cognitive disorders
  • Hypoaesthesia
  • Paraesthesia
  • Spasms
  • Ataxia
  • Pain
  • Optic neutitis
  • Diplopia
  • Nystagmus
  • Dysarthria
  • Dysphagia
  • Incontinence of stools and/or urine
  • Retention of stools and/or urine

Though present in many other condition but still regarded as classical symptom of Multiple Sclerosis called “Lhermitte’s Phenomenon” is observed in many cases; where in; patient feels electric shock like pain running up and down the spine and through the spine towards the limbs.

Uhthoff’s Phenomenon is seen in patients with demyelinating diseases especially in Multiple Sclerosis, wherein the nerve impulse conduction is blocked whenever the body gets overheated due to hot climate or over exercise or fever etc. and symptoms subsides as soon as body temperature normalises.

Scales to Measure Severity and Quantifying Disability of MS

  • Multiple Sclerosis Composite – It is a scale developed by National Multiple Sclerosis Society to measure severity of MS basically used by reasearchers. It is based on testing timed movement of arm walking and cognitive ability.
  • Expanded Disability Status Scale (EDSS Scale) – Quntifies disability in eight different Functional System each having its own score based on clinical findings

CAUSES AND PATHOPHYSIOLOGY OF MULTIPLE SCLEROSIS

Multiple Sclerosis typically shows lesions with inflamation and cholestrol crystal deposits resulting into destruction of neuronal myelin sheath.

MS is believed to be partly immune mediated disorder, if not fully. Still its exact causative factors are not known but is believed to be combination of genetic and environmental factors.

It is believed that inflamatory process is triggered due to T-cell that crosses Blood-Brain Barrier and enters brain due to increased permeability of capillaries as a result of infection or some other unknown factors. This infiltration and harbouring of T-cell into brain causes inflamatory process which not only directly damages myelin sheath but also damages oligodendrocytes which are responsible for production and regeneration of myelin sheath. Thus resulting into deficient myelin sheath. Also there is seen release of astrocytes due to dying oligodendrocytes and cholestrol crystal deposits which further triggers inflamatory process damaging even further. The inflamatory process finally leaves behind scars or so-called “Plaques of Multiple Sclerosis”.

Multiple usually damages myelin sheath of white matter. Myelin sheath is responsible for electrical signal conduction and White Matter is responsible for conduction of signals between two regions of Grey Matter. A deficient or damaged myelin sheath results into deficient signal conduction.

Its observed that MRI taken during acute episode of MS typically show more scars or so-called Sclerotic Plaques of Multiple Sclerosis compare to MRI taken later on. This indicates that to some extent brain has capablity to recover many of the damages after an acute episode of MS.

DIAGNOSIS OF MULTIPLE SCLEROSIS

There is no definitive test available for confirmation of Multiple Sclerosis. Even risky and invasive technique like Biopsy is not definitive.

Usually non-invasive techniques like Intravenous Injected Gadolinium Contrast MRI are used in suspected cases. Gadolinium doesnot cross normal blood brain barrier, so if found in brain after Intravenous injection it suggests leaky blood brain barrier.

HOMEOPATHIC MEDICINES FOR MULTIPLE SCLEROSIS

  • GELSEMIUM
  • CIMICIFUGA/ACTEA RACEMOSA
  • TERRENTULLA HISPANICA
  • NUX VOMICA
  • STRYCHININUM
  • NAJA
  • LACHESIS
  • LYSSINUM
  • ACONITUM
  • OPIUM
  • RUTA GRAVEOLENS

PARKINSON’s DISEASE

Parkinson’s Disease is a chronic, slow progressive, degenerative disease of central nervous system affecting the motor neurons.

There is gradually increasing cell death in subsrantia nigra resulting in reduced dopamine secretion with accumulation of abnormal alpha-synuclien (lewy bodies) in remaining neurons due to which its classified under Synucleopathies.

It is characterised with parkinsonism, where in, patient has tremors, bradykinesia, rigidity and postural instability. Patients with parkinson’s disease also presents with neuropsychiatric disorder(mood, cognition, thought, behavioural). Parkinson’s Disease is also called Idiopathic Parkinsonism.

CAUSES OF PARKINSON’s DISEASE

Causes of Parkinson’s Disease are not known but it is believed to be due to environmental and genetic factors and has familial predesposition towards the condition. Those who has history of head injury, psychological stress, frequently exposed to certain toxins, have increased risk of developing Parkinson’s Disease. It is found that those addicted to stimulants like tobacco smoking tea and coffee are less prone to this condition.

There are certain genes identified, mutations in which are believed to increase the risk of developing Parkinson’s Disease viz.

  • SNCA – responsible for production of normal Alpha-Synuclein, an essential protein.
  • PARK7 – Encodes Protein Deglycase DJ-1 also called parkinson disease protein 7, inhibits aggregation of alpha-synuclein and protects neurons from oxidative stress and cell death
  • LRRK2 – responsible for production of Dardarin(Lucine-Rich Repeat Kinase 2) an essential cytoplasmic protein.
  • GBA – responsible for production of Beta – Glucocerebrosidase an essential enzyme localised in lysosome which has essential intermediate role in metabolism glycolipid (abundantly present in cell membrane)
  • PRKN – responsible for production of Parkin a ligase responsible for labelling molecules covallently with ubiquitin (ubiquitination) for degradation in proteosome or lysosome.
  • PINK1 – responsible for production of PTEN Induced Kinase 1 is a mitochondrial serine which is involved in process of quality control check on mitochondria where in damaged mitochondria are identified and recruited for degradation this its believed to protect cells from stress induced mitochondrial damage.
  • VPS35 – Encodes Vacoular Protein Sorting-associated protein 35 is component of retromer complex responsible for retrograde transportation of proteins from endosomes to trans-Golgi network.
  • EIF4G1 – encodes Eukaryotic Translation Initiation Factor 4 Gamma 1 involved in process of mRNAcap recognition, ATP dependent unwinding 5′-terminal secondary structure and recruits mRNA to ribosome
  • DNAJC13 – encodes “DnaJ(Hsp40), homolog, subfamilyC, member13”, involved on endosome organisation.
  • CHCHD2 – Encodes protein called “Coiled coil Helix Coiled coil Helix Domain containing 2”, it acts as negative regulator of mitochondrial apoptosis

SYMPTOMS OF PARKINSON’s DISEASE

Although Parkinson’s Disease is classically recognised by 4 cardinal symptoms of parkinsonism viz tremor, bradykinesia, rigidity, postural instability which belong to sphere of motor neurons, Parkinson’s Disease also presents non motor symptoms of autonomic nerves and neuropsychiatric symptoms(cognitive, behavioural, mood, thoughts) of which neuropsychiatric cognitive deficits tends to appear in very early stage of disease even before classical cardinal motor symptoms are perceptible but its often not properly evaluated or linked to PD by physicians and diagnosis is delayed. Also sleep disorder starts appearing in patients years before motor or other neuropsychiatric symptom appear like somnolence, insomnia, REM sleep behavioural disorder(RBD) where in dreamy sleep patient starts acting and may inflict injury to self or others in bed.

MOTOR SYMPTOMS

Tremors

  • Comes during rest and subsides on active voluntary motion and in deeper stages of sleep.
  • Usually tremors ranges 4-6Hz per second
  • Classically many patients presents with a common pill-rolling pattern of tremor, where in, thumb and index finger are set in circular motion as if making pill manually.

Bradykinesia

  • Slowness of movement throughout its course right from planning the course of movement to execution of movement.
  • Slughishness and difficulty in day to day routine activity
  • Impaired sequential and simultaneous movements.

Rigidity

  • Increased muscle tone causes rigidity in limbs.
  • Initially rigidity may be due to pain in joints and typically starts asymetrically from neck and shoulder and in later stages of disease whole body is involved.
  • Rigidity may be Uniform (Lead-Pipe Rigidity) or Retchety(Cogwheel rigidity)

Postural Instability

  • Appears in later stages of disease
  • Festination
  • Forward flexed posture
  • Freezing of gait as if feet were made of wood and were stucked to ground especially while turning or changing direction.
  • Toneless flat and sluggish voice
  • Mask-Like facial expressions or hang-dog appearance
  • Postural Instability also causes lack of balance and falls causing various injuries.

NEUROPSYCHIATRIC SYMPTOMS

Cognitive

Cognitive Disorders causing dificulty in Executive Functions due to cognitive difficulty in.

  • Planning Action
  • Flexibility
  • Abstract thinking
  • Rule Acquisition
  • Inhibiting inappropriate action
  • Initiating appropriate action
  • Memory
  • Attention
  • Processing speed
  • Recall – needs cues
  • Perception and estimation of time
  • Visuospatial – face recognition and geometric Orientation

Behaviour, Thoughts and Mood

  • Depression
  • Apathy
  • Anxiety
  • Hallucinations
  • Illusion
  • Delusion
  • Dementia
  • Psychosis with delusion and associated delirium
  • Paranoid ideation

NON-MOTOR AUTONOMIC SYMPTOMS

These symptoms in most appears years before the disease is classically diagnosed

  • Orthostatic Hypotension
  • Oily Skin
  • Copious perspiration
  • Incontinence of Urine
  • Sexual Dysfunctions
  • Fatal Gastric Dismolity
  • Fatal Constipation
  • Altered olfaction
  • Visual disturbances
  • Paraesthesia limbs

HOMEOPATHIC MEDICINES FOR PARKINSON’s DISEASE

  • TARRENTULA HISPANICA
  • THUJA OCCIDENTALIS
  • AETHUSA CYNAPIUM
  • LACHESIS
  • NAJA
  • STANNUM METALLICUM
  • ZINCUM METALLICUM
  • LYSSINUM
  • OPIUM
  • BELLADONNA

PARKINSONISM

Parkinsonism is a disorder characterised by tremors, twitching, trembling, bradykinesia, stiffness and rigidity causing gait and postural imbalances. It is present in many disease conditions especially in Parkinson’s Disease from which it derives its name.

CAUSES OF PARKINSONISM

  • Neurodegenerative Diseases Parkinson Plus Syndrome
  • Metabolic disorders
  • Vascular disorders
  • Drugs
  • Toxins
  • Trauma
  • Neoplasms
  • Immune Mediated
  • Infections

PARKINSONISM PRESENTS ITSELF IN FOLLOWING DISEASES

NON INFECTIOUS DISEASES

  • Parkinson’s Disease
  • Dementia with Lewy Bodies
  • Parkinson’s Disease Dementia
  • Rapid Onset Dystonia Parkinsonism
  • Autosomal Recessive Juvenile Parkinsonism
  • X-linked Dystonia Parkinsonism
  • Parkin Mutation (Hereditary Juvenile Dystonia)
  • Corticobasal Degeneration
  • Fronto-Temporal Dementia
  • Gertsmenn Straussler Scheinker Syndrome
  • Progressive Supra-neuclear Palsy
  • Olivopontocerebellar Atrophy
  • Multiple System Atrophy (Shy Drager Syndrome)
  • Lytico Bodig Disease (ALS complex of Guam)
  • Neuroacanthocytosis
  • Neuronal Ceroid Lipofusinosis
  • Pantothenate-Kinase Associated Neurodegeneration
  • Hutington’s Disease
  • Wilson’s Disease
  • Binswanger’s Disease
  • Hyopthyroidism
  • Vascular Dementia
  • Paraneoplastic Syndrome
  • Orthostatic Tremor
  • Chronic Traumatic Encephalopathy

INFECTIOUS DISEASES

  • Creutzfeldt Jakob Disease
  • Encephalitis Lethargica
  • HIV/AIDS

HOMEOPATHIC MEDICINES FOR PARKINSONISM

While treating Parkinsonism its of utmost importance to first diagnose the underlying cause and treat the cause first.

Certain Homeopathic medicines that can be administered based on Symptomatic presentation and pathological background examples given are theraputic based, relate patients symptoms to that of medicine before selecting.

  • TERRENTULA HISPANICA – Well indicated in patients with neurodegenerative disorders. Orthostatic Tremors.
  • GELSEMIUM SEMPERVIRENS – due to psychosomatic reasons. Orthostatic tremors.
  • RUTA GRAVEOLENS – due to neoplasms in Central nervous system.
  • LYSINUM/HYDROPHOBINUM/LAC CANNUM – Typically suits in cases with dementia of Lytico-Bodig disease
  • BELLADONNA – Typically suits well in cases due to inflamatory or congestive or infective origin like that in Creutzfeldt-Jacob’s disease and Encephailitis Lethargica.
  • ARNICA MONTANA – Typically Suits well in cases due to Chronic Traumatic Encephalopathy.
  • BAPTISIA TINCTORIA – accompanying delirium typically of infective origin
  • NUX VOMICA – Typically suits well in cases due to bad effects of drugs and toxins.
  • CROTALUS HORRIDUS
  • LACHESIS
  • HYOCYAMUS
  • ACONITUM NEPALLUS
  • AGARICUS MUSCARIOUS
  • DIGITALIS PURPUREA

CARPEL TUNNEL SYNDROME CTS

CARPEL TUNNEL SYNDROME CTS is a condition where in the compression symptoms arise due to bundle compression of structures that pass within carpel tunnel affecting the the Median Nerve.

WHAT IS CARPEL TUNNEL?

CARPEL TUNNEL is normal anatomical structure in our body found in every normal individual. It is formed by carpel bones forming a groove as its floor on dorsal side of hand and flexor retinaculum forming the flat roof of carpel tunnel on palmar side of hand.

It provides attachment and passage at the wrist level for the structures to pass through arm to hand. Muscles related to flexing movements of finger pass through this tunnel alomg with median nerve

Structures Passing Through Carpel Tunnel

  • Flexor Digitalis Superficialis – 4 tendons
  • Flexor Digitalis Profundus – 4 tendons
  • Flexor Pollicis Longus – 1 tendon
  • Median Nerve
  • Flexor Carpi Radialis not exactly pass within the carpel tunnel but it traverse through Flexor Retinaculum that is forming the roof of carpel tunnel.

CAUSES OF CARPEL TUNNEL SYNDROME

Anything that exerts pressure to median nerve giving rise to nerve compression symptoms cause carpel tunnel syndrome. In most cases the cause remains obscure and are idiopathic. Any inflamatory process or water retention or metabolites deposition within tissue may cause increase in volume of structures and total content within the carpel tunnel and will cause in pressure of whole bundle which may cause Carpel tunnel due to increased bundle pressure, similarly the adjecent structures to carpel tunnel if inflamed or injured or any overgrowth of it, may exert pressure on carpel tunnel and median nerve within giving rise to carpel tunnel syndrome. Mechanical reasons like wear-tear and injuries are mostly regarded as major factors with ageing and certain genetic, structural and physiological anomalies are known to increase the risk of Carpel Tunnel Syndrome.

Age and Gender

  • Age – Ageing plays a major role in development of CTS its more commonly found in age above 40yrs
  • Gender –  Female sex is more prone to this condition compared to male.

Mechanical

  • OCCUPATIONAL – Work related frequent repetitive forceful pressures jerk and vibrations on hand on regular basis where in there is no sufficient time given to repair the wear and tear and the damage tend to accumulate over time.
  • POSTURAL HABBITS such that it exerts unusual strain on hand and wrist on regular basis.
  • INJURIES to wrist distal part of forearm and wrist. Fractures involving radius ulna carpel and metacarpel bones like Colle’s Fracture, Boxer’s Fracture etc.

Genetic and Systemic 

  • Prediabetics and Diabetics
  • Obesity
  • Metabolic Syndrome
  • Hypothyroidism
  • Arcomegaly
  • Amyloidosis
  • Rheumatoid Arthritis
  • Gout
  • Tumours
  • Hereditary Neuropathy with Susceptibility to Pressure Palsy – Carcot Marie Tooth Syndrome casused due to mutation in gene HS3TC2
  • Narrow Carpel Tunnel
  • Certain drugs like Corticosteriods or Oestrogen therapy.

SIGNS AND SYMPTOMS OF CARPEL TUNNEL SYNDROME

  • Paraesthesia in Index finger, Middle finger, Thumb and the lateral half of  Ring finger
  • Myalgias or neuralgia in forearm upwards to arm, less commonly in wrist and hand
  • Loss of strength of grip and Loss of Manual Dexterity
  • Atrophy of muscles at the base of thumb visible on proximal, thumb-related quadrant of palm (ie proximal lateral quadrant/upper outer quadrant).

HOMEOPATHIC MEDICINES FOR CARPEL TUNNEL SYNDROME CTS

  • HYPERICUM
  • CIMICIFUGA/ACTEA RACEMOSA
  • AGARICUS MUSCARIOUS
  • ACTEA SPICATA
  • PLANTAGO
  • BELLIS PERENIS
  • ARNICA MONTANA
  • GELSEMIUM SEMPERVIRENS
  • TARRENTULA HISPANICA
  • GNAPHALLIUM

SHIV-LING – VEDIC NUCLEAR REACTOR MODEL?

SHIV LING and NEUCLEAR REACTOR
SHIV LING and NEUCLEAR REACTOR

Shiv Ling Vedic Model of Nuclear Reactor?

Shivling is found on earth on almost all continents with its reference found in vedic literature and archeological findings date it back to thousands of years, back in vedic era.

I was always confused when I got to know that many people obscenely depicting Shivling falsely as some body part of Shiv due to word “Ling”, where as its a formless god for vedic culture and symbol of creation, maintenance and destruction.

Its well said by Mahatma Gandhi that “Each one prays to god in his own light” – So this also explains that it reflects one’s knowledge, character and personality that how he percieves everything.

Vedas are compilation of poetic verses with vast knowledge of science, society and universe, its a bare act of nature. Each verse is being crafted with extreme efforts to preserve and carry forward to next generations, numerous messages in shortest, most perfect and meaningful sentence. Its compiled in poetic verses as there are many dimensions to each aspect of nature that simple language cannot explain and its not something only to be undertood but its has more dimensions to it, as it needs to be felt and realised to understand it and so the poetic verses, symbolisation and personification are the best ways that can carry the message in depth to next generation.

Its difficult for us to understand and  explain lord shiva like the way Vedas do and the understanding Vedas give to one who meditates each shlok in depth of it. But still if one has to attempt to explain, then the frequently used explanation is that Shiva is Formless, Omnipotent, Omnipresent, All pervaded by him, Creator, Maintainer, Destroyer, Nothingness, Final Emancipation, The Auspiciois One and many more attributes,  to understand each of the above aspects better, we need to understand aspects of nature, physics and emotions with all its dimensions first.

Shiva is mostly worshiped in form of Shivaling and only personified form that it is worshiped is Nataraj form where its also called the dance of Lord Shiva, now this personified representational form as per worlds largest particle physics laboratory (CERN) is beautiful dipiction of harmonious motion of electron with respect to other sub-atomic particles and so they have placed large Natraj Idol at the entrance of CERN’s Large Hadron Collidor and many physics and religious scholar after going through Vedic literature and current science findings believe Shiva to be depiction of some sub-atomic field that makes the basic fabric of whole universe, so recently found Higgs Bosson was termed as God-Particle.

Now if we further relate one of the representational form of Shiva, that is the  Shiv Ling, then its dome shaped with water continiously being dropped over it with channels around it to drain the water off, Shiv ling are almost always found near large water resource like river or sea, so that it get continous water supply and draining. The drained water is prohibited to touch or consumed as its regarded unsafe for health.

Now of we compare Shivling with Neuclear Reactors, Nuclear Reactors are dome shaped, needs continious robust water supply to keep it cool and are built near large water resources like sea, with channels of water drainage. Also certain wastes from Neuclear plant are radioactive and dangerous to come in contact with.

And also looking at above explained aspects and belief of scientists about the Shiva, “The Shiv-Ling as Neuclear Reactor Assumption” has got good chance to not to get rejected as probable model of Neuclear Reactor or even something related beyond it.

DID I DECODE SWASTIK? CHEMICAL FROMULA THAT GIVES LIFE AND GIVES MOTION TO BREATH?

SWASTIK CHEMICAL FORMULA FOR BREATH AND LIFE
SWASTIK – CHEMICAL FORMULA OF LIFE H4CO4 in SANSKRIT LANGUAGE “SWAAS” = BREATH “TIK” = MOTION or LETTING OUT

SWASTIK is regarded as very auspicious symbol in Hindu religion with its origin in in Vedic culture

Vedas are oldest known literary work on Earth and are considered as authorless. In Hinduism Vedas are regarded with highest order amongst all religious and spiritual scriptures and all other scriptures are derivative of vedas or should correspond to ideas of vedas, it is considered as the bare act of nature.

Swastik symbol is found in almost all continent in excavation work and its considered to be the oldest symbol ever found on earth with its reference in almost all the cultures around the world. Especially in Hinduism Swastik is consodered very auspiciois and it is used in each and every religious and spiritual activities.

The best way to pass on data is in easy symbol forms, so that any civilization, if not knowing a particular language, even they can decode and understand.

Because of all these factors Swastik always made me wonder what it must encoding within, as vedic culture is known to be rich in knowledge and vedic culture forwarded knowledge in form of poetic verses and symbols.

So finally while studying carbon and carbon compounds I came across carbon atom which has valency of 4, Oxygen has valency of 2 and Hydrogen with valency of 1.

These three atoms if placed in Swastik with Carbon in center oxygen at the turn of each limb and hydrogen at end of each limb forms a complete chemical code of Swastik H4CO4 or H(CO)4

Now wether they actually meant this or something else? Is it symbol for chemical formula that they made or they wanted to represent something else? So now if we try to further decode we can break word “SWAS-TIK” into two simple words

  • “SWAS”  means breath and
  • “TIK” means motion or letting out in sanskrit language.

LINK OF SWASTIK CHEMICAL COMPOUND IN RESPIRATORY PROCESS

Now further we are able to match this chemical code with the meaning of these two words “SWAS” and “TIK”

Swatik is highly unstable compound on planet earth with its atmosphere and  its atmospheric pressure doesnt let it thrive as it requires extremely high pressure to thrive otherwise on  it decomposes soon into the nearest stable compound 4HCO4 decomposes into Carbonic Acid and Water as shown in chemical formula below.

4HCO4 ➡  CH2O3 + H2O

CH2O3 has important role in respiratory process. It is the only acid secreted by lungs in the form of gas and it is described as “Volatile Acid” or “Respiratory Acid”.

So is swastik related to a very unstable intermediate osscilatory substance which though not actually comes into form but remains intermediate exchange form and plays a major role in respiratory process and respirations constant osscilation.

??? SO DOES SWASTIKA MEANS THE COMPOUND THAT GIVES MTOIN AND OSSCILATION TO RESPIRATION AND IS SOMWTHING THAT HAS ROLE IN LEAVING OUT THE BREATH

SWAAS = BREATH

TIK = MOTION OR LETTING OUT

TRIGGER FINGER

TRIGGER FINGER or TRIGGER THUMB is a condition where in joints of one or more of the digits(finger/thumb) gets stucked up/locked up at certain postion which is difficult to move and moving it with force may cause popping or clicking sound with pain.

Though it can present in any sex and at any age, it is more commonly found in females around age of 50-60 yrs.

CAUSES OF TRIGGER FINGER/THUMB

Its is also termed as digital Stenosing Tenosynovitis, although there is no predominant inflamation to Tendosynovium but inflamation is found in Tendon Sheath. And also its not comfirmed that inflamatory process has any primary role in its development

Though exact cause behind trigger finger/thumb is not known but the risk factors that tend to increase the incidence of this condition are identified

  • Over straining and over use of hand and fingers espescially activities involving prolonged forceful flexion of digits(fingers/thumb) may be occupational or habbitual routine activities.
  • Frequent injuries – occupational, accidental or even injuries of planned surgery of hand especially ofter surgery for carpel tunnel syndrome
  • Systemic connective tissue disorders
  • Autoimmune diseases especially Rheumatoid Arthritis
  • Hypothyroidism
  • Renal Disease
  • DeQuervain’s Diseases
  • Amyloidosis
  • Diabetes Mellitus and Other Metabolic disorders.

SYMPTOMS OF TRIGGER FINGER/THUMB

  • Though it may involve any digit(thumb/finger) Index finger and Thumb are more frequently involved. One or more digits may be involved.
  • Patient presents with stucked up digit at certain position. It may be at any level from flexed  to extended position usually found at semiflexed position.
  • This locking up may be persistent for a prolonged period of time or may be momentary and recurrent.
  • Aggravations are more commonly experienced at night, especially while holding heavy article with hand or while gripping or applying pressure with fingers or hand.
  • On moving and or forcefully unlocking the stucked finger is bit painful and causes clicking and popping sound
  • In severe cases the finger may be persistently locked for prolonged period of time with constant pain which may also extent to whole hand and wrist.

DIAGNOSIS OF TRIGGER FINGER/THUMB

Diagnosis of trigger finger/thumb is based on clinical symptomatology of the patient where in inflamation or involvement of tendon sheath of flexors is confirmed and excluding probability of other condition like

  • Tumour
  • Sprain of digit
  • Osteoarthritis of metacarpo-phalangeal joint
  • Fracture
  • Tendon Entrapment post-trauma
  • Extensor Apparatus Injury
  • Game Keeper’s Thumb
  • Sesamoid anomaly
  • Dupuytren’s Contracture
  • Focal Dystonia

An injection of lidnocaine in tendon sheath of flexors reduced the pain then it confirms diagnosis Trigger Finger/thumb.

HOMEOPATHIC TREATMENT FOR TRIGGER THUMB

Treatment of trigger finger/thumb is dependent on combination of modalities of physiotherapy, splinting and medication.

HOMEOPATHIC MEDICINES FOR TRIGGER THUMB/FINGER

  • CALCAREA FLOURICA
  • SILICEA
  • THIOSINAMINUM
  • RHUS TOXICODENDRON
  • ACTEA SPICATA
  • THUJA OCCIDENTALIS
  • AGARICUS MUSCARIOUS
  • ARNICA MONTANA
  • BRYONIA ALBA
  • CIMICIFUGA RACEMOSA

REACTIVE ARTHRITIS

Reactive Arthritis was also called Reiter’s Arthritis is RF-negative and HLA-B27 Linked Imflamatory oligoarthritis typical with Enthesitis, accompanied with Inflamatory occular and/or inflamatory genitourinary and other systemic manifestation usually post gastrointestinal or genitourinary infection.

During world war one and two many cases emerged with the Triad of Symptoms viz. Inflamation of Joints, Inflamation of eyes and Inflamation of Uretha. Which drew attention of medical community due to common presentation in many giving it some syndrome like picture. On further investigations it was found out that most of them were exposed to urogenital or Gastro-intestinal infection 1-4 weeks prior to onset of this Triad of Symptoms. This was initially termed as “Fessenger-Leroy-Reiter’s Syndrome” or simply  “Reiter’s Syndrome”. But as the physician Hans Conard Julius Reiter  was involved in attrocities and war crimes with Hitler, so his name was removed and later renamed and termed as “Reactive Arthritis”.

EPIDEMIOLOGY OF REACTIVE ARTHRITIS

  • AGE – It more frequently affects age group of 20-40 years.
  • SEX – It is more common in Males then in Females.
  • ETHNICITY – Due to its association with HLA-B27 it is frequently found in white race compared to dark race as comparatively HLA-B27 occurs more commonly in white population.
  • RISK FACTOR – Person with HIV positive status are more prone to develop reactive arthritis.

SIGNS AND SYMPTOMS OF REACTIVE ARTHRITIS

The onset of symptoms of Reactive Arthritis typically starts 4-35 days after an initial infection of gastro-intestinal system or genito-urinary system.

TRIAD OF REACTIVE ARTHRITIS

Reactive arthritis in most of the cases presents where patient cant – SEE, PEE, climb the TREE! due to following Classical Triad of Symptoms of reactive arthritis

i) OLIGOARTHRITIS

Oligoarthritis involving less than five joints. It may frequently involve knee and sacroilliac joint as well. May present itself in additive pattern where it starts with one joint and add another joints subsequently or it may be migratory in pattern where the set of inflamed joints keep changing by addition and simultaneous substraction of joints involved.

ii) NON-GONOCOCCAL GENITOURINARY INFLAMATION

Inflamation of genitourinary system classically presents itself at the onset of the disease. Not always but in many its typically after initial sexual exposure. It presents as frequent burning micturation, uritheritis, prostatitis, balanitis in men and salpingitis, vulvitis and vaginitis in women.

iii) OCCULAR INFLAMATION

Occular Inflamation may present itself as mild conjunctivitis or uveitis in 75% of cases with gastrointestinal origin and 50% of cases with urogenital  involvement. patients have intermittent irritation in eyes with blurred vision typically commences at onset of disease.

OTHER SYMPTOMS

  • Few patients also presents with peculiar symptom which is specific to reactive arthritis, its Keratoderma Blenorrhagica which are small hard nodule commonly appear on soles occasionally on palms and rarely on other parts of body subcutaneous nodules are not incluced. Even in absence of above mentioned triad of symptom the presence of Keratoderma Blenorrhagica is diagnostic for reactive arthritis.
  • In reactive arthritis; typical to HLA B27 related immunological reactions; involves Entheses that is where skeletal muscles attaches with bones through tendons, where it causes Enthesitis and tendon inflamation especially the tendo-achilles and also fascia in particular Plantar Tendinitis.
  • Occasionally patients also suffer from dactilitis giving finger sausage-like apperance “sausage finger” due to inflamation.
  • Mucocutaneous involvement presents as ulcerative or non ulcerative stomatitis, apthous ulcers and geographic tongue are also seen as presentation of this disease
  • Cardiac involvement causing pericarditis and aortic regurgitation in cases which do no recover soon or if its recurring or progressive.
  • Gastrointestinal manifestation like pain and cramps with frequent semiformed stools with mucous and insome cases blood due to  inflamation and ulcceration in gastrointestinal tract.

Most of the cases of Reactive Arthritis recover within six months, in many cases it keeps comming back time and again and in few it becomes chronic and progressive which may increase risk of severe complications.

COMPLICATIONS OF REACTIVE ARTHRITIS

In chronic progressive and recurring cases the patient may develop following complications

  • Ankylosing Spondylosis
  • Disabling Arthritis
  • Aortitis
  • Aortic Regugitation
  • Conduction defects of Heart
  • Pericarditis
  • Amyloid deposits
  • Immunoglobulin A Nephropathy

CAUSE OF REACTIVE ARTHRITIS

Reactive Arthritis is is HLA B27 linked inflamatory arthritis and enthesitis preceeded by a spell of infection either of genito-urinary system  or gastro-intestinal system by following commonly involved organisms

GENITO-URINARY INFECTIONS ASSOCIATED WITH REACTIVE ARTHRITIS

  • Chlamydia Trachomatis
  • Ureaplasma Urealyticum

GASTRO-INTESTINAL INFECTIONS ASSOCIATED WITH REACTIVE ARTHRITIS

  • Salmonella Spp.
  • Shigella Spp.
  • Campylobacter Spp.
  • Yersinia Spp.

4-35 days after the spell of urethritis or food poisoning by above mentioned organisms the symptoms of reactive arthritis sets in, where the synovial fluid has negative culture ans is free from infection and but the HLA B27 linked  inflamation is thought to be triggered due to

  • Autoimmune reaction due to cross reactivity of micro-organism antigen with joint tissue  or
  • Micro-organism antigenic components that may have settled in joint tissue.

DIAGNOSIS OF REACTIVE ARTHRITIS

Clinically the Reactive Arthritis can be diagnosed with help of Sensitivity and Specificity Guidlines laid down by American College of Rheumatology, for clinical diagnosis with given set of presenting symptom, its as follows

  1. Arthritis > 1 month with Urethritis and/or cervicitis has  sensitivity of 84.3% and specificity of 98.2%.
  2. Arthritis > 1 month with Urethritis or Cervicitis or bilateral Conjunctivitis has Sensitivity of 85.5% Specificity of 96.4%.
  3. Arthritis, Urethritis and Conjunctivitis has Sensitivity of 50.8% and sensitivity of 98.8%.
  4. Arthritis > 1 month, Conjunctivitis and Urethritis has Sensitivity 48.2% and Specificity of 98.2%.

Patients falling in above criteria or those showing just Keratoderma Blenorrhagica without any other symptoms and other suspected cases can be sent for following test for further evaluation.

  • HLA B27 testing
  • Urine routine and culture
  • STOOL Routine and culture
  • Throat swab culture
  • Cervix and Urethral swab culture
  • Erythrocytes Sedimentation Rate
  • C-Reactive Protein Test

HOMEOPATHIC TREATMENT FOR REACTIVE ARTHRITIS

Being an immune mediated systemic reaction that too the one that is triggered with different causative agents and even to same agents different individuals will respond differently.

Though they may have same set of general symptoms like the classical triad of reactive arthritis but intensity of each of the symptom of triad will differ in each individual,

Now this is where the homeopathic individualisation process starts. In Homeopathy we believe that though majority of human genome is the same but the minor variations in gene and the epigenome make the whole lot of difference in various characteristerics of each individual, similarly their immune reaction also varies, so every person should have individualised medicine.

Homeopathic Treatment is based on symptom similarity and individualisation of case based on peculiar symptoms based on which the case is individualised and medicine is selected.

Alternatively as per Homeopathic principle of Genus Epidemicus or pathology based symptomatology there can be disease specific homeopathic medicine derived from common symptomatic representation of a disease condition in a group of population.

Now this can not be the most similimum homeopathic prescription but roughly it can hit the disease condition within an indivudual though not accurate but will yeild some results in most of the cases.

To yield best homeopathic results there can be no generalised common approach for all cases.

But still if we have to attempt common standardised pathology based approach then to give some guidelines on homeopathic approach towards cases of reactive arthritis I have attempted following rough guidelines which may help to give some vision in approach towards such cases.

Its seen that in few case it begins after gastro-intestinal infection and in some case post genito-urinary infection. So this will further guide determining “morbid cause” behind the disease directing us in homoeopathic similimum medicine selection.

Now reactive Arthritis shows a triad of symptom in most of the cases. So this triad helps us to reach to group of medicines with such combination of symptoms.

Intensity, occurance of symptoms and its sequence in triad differs in each individuals. For example

  • In some person urogenital symptoms may be more severe compared to occular symptoms or arthritis symptoms, where as in others arthritis and ocular symptoms would be more severe than urogenital symptoms.
  • Some may not have occurence of  conjunctivitis
  • In some all three triad occur at a time where as in some patients it may occur gradually one after another in different sequence.

All this helps us find out the “seat of disease” in an individual and its degree of affinity towards various organs which can be related to homeopathic medicines during selection process.

Further arthritis may show different pattern like

  • progressive
  • migratory
  • additive
  • symetry
  • predominantly involved joint
  • sequence of joint involvement
  • number of joints involved
  • severity
  • intensity
  • type of sensation and other symptoms

Also similarly symptoms of occular involvement and urogenital involvement should be take in to account in absolute detail. This further helps refine and classify the patient and the respective medicines to be repertorised.

Which other systems and organs are involved like mucous membranes, skin, heart, kidney etc and what type of pathology they are showing like tissue destruction or just inflamation and functional disturbance or tissue lysis with regenerated and degenerative changes this will help to decide what “type of miasm” is underlying wether its psoric, syphillitic or psychotic type pathology.

Certain symptom are very “peculiar” for the  disease and occurs in few individuals like Keratoderma Blenorrhagica eruption, now location of this eruption will further help individualise the case.

Enthesitis – Inflamation of tendo-achilles and plantar fascitis is  “very specific” to the disease but does not occur in all individuals, so if plantar fascitis or inflamation of tendo-achilles if occurs in someine with this disease then it helps further in individualisation of during homeopathic medicine selection.

Other than this the general health and family background should be noted to derive  constitutional types and association of HLA B27 in 75% of this individual further helps in individualisation and homeopathic medicine selection.

COMMONLY USED HOMEOPATHIC MEDICINES FOR REACTIVE ARTHRITIS

  • PHOSPHORUS
  • ARSENICUM ALBUM
  • RHUS TOXICODENDRON
  • BRYONIA ALBA
  • LEDUM PALUSTURE
  • THUJA OCCIDENTALIS
  • ANTIMONIUM CRUDUM
  • ARGENTUM NITRICUM
  • BORAX
  • MERCURIOUS SOLUBILIS
  • PULSATILLA NIGRICANS